Proposition 106 was proposed to amend the Arizona Constitution by barring any rules or regulations that would force state residents to participate in a health-care system. The proposed amendment would also ensure that individuals would have the right to pay for private health insurance.[3]

Aftermath

Dr. Eric Novack, who was the major supporter behind the measure, stated that the approval of the measure was not the final step in his campaign against federal health care mandates. Dr. Novack stated that he had drafted a document called, "A Blueprint for a Sustainable Safety Net Healthcare System." Dr. Novack is the leader of the U.S. Healthcare Freedom Coalition, and planned to promote the blueprint through the organization.[4]

Text of measure

Ballot title

A "yes" vote shall have the effect of prohibiting the enactment of laws or rules that require any person, employer or health care provider to participate in any health care system. It will also allow a person or employer to forgo health insurance and pay for health care services directly without a penalty and will allow health care providers to accept direct payment without a penalty. It will specifically allow health insurance in private health care systems.

A "no" vote shall have the effect of retaining the current law regarding a person or entity's health care choices.[6]

Constitutional changes

Support

Supporters

Governor of ArizonaJan Brewer endorsed the measure, stating, "I support Proposition 106 and have every reason to believe that Arizona voters will overwhelmingly pass this measure. And, when they do, a clear message will be sent to the president and Congress that this type of overreaching by the federal government will no longer be tolerated."[9]

Former presidential candidate Steve Forbes and U.S. Representatives John Shadegg of Arizona stated their support for the measure, citing freedom of choice in the health care issue. Both men stated that there were significant holes in the health care proposal being considered in Congress.[11]

Rep. Barto speaks about Health Care Freedom Act

According to Forbes: "Allowing individuals to make their own choice is the essence of freedom. You don't have to buy something if you don't wish to buy it. You should have those choices. This amendment would make that possible.”

According to Shadegg: “We in Arizona believe that health care is an intensely personal matter and that no law should be able to stop anyone in this country - certainly not in this state - from spending their own money to buy the health care services that they want, and no one should be compelled to spend their money on health care services they don't want."

According to reports, three out of four members of the National Federation of Independent Business opposed the measure. The group stated that 77 percent of its state membership had come out in opposition to the health care insurance proposal.[12]

Dr. Donnie Sansom, an anesthesiologist from Tucson, stated about the measure, "People are afraid for their health care. I have a great problem with my government saying, 'You have to purchase this.' It's unprecedented...Prop. 106 is about ensuring you have individual freedoms in place."[13]

Linda Turley-Hansen, syndicated columnist and former Phoenix TV anchor, advised a 'yes' vote on the measure in an editorial revealing her recommendations for all the propositions on the November ballot.[14]

Arguments

It would "protect the rights of Arizona to determine its own, best health care system."[16]

"Many Americans look at a federal overhaul of healthcare as a threat, and don't see how they will benefit from covering millions of uninsured people at taxpayer expense."[17]

According to Biggovernment.com: "The federal government has a limited set of enumerated powers, while everything else is reserved to the states and the people. None of these powers includes the ability to force people to purchase health insurance, or anything else for that matter."[18]

In an opinion piece written by Dr. Eric Novak of Glendale, Arizona, supporter of a similar 2008 initiative, he tried to clear up a misinterpretation about the proposed bill on Politico.com. The wrong "assertion" came in another opinion piece that appeared on the website on October 28, 2009. Dr. Novak stated in his writing:

The Health Care Freedom Act was born from an idea that I had in 2006, when the health care system was just as unsustainable, and the desperate need for reform was as equally apparent as it is today. The principle was and remains simple: Unless we act decisively to protect the rights of Americans and their families to remain in control of their health and health care decisions, those rights will be sacrificed on the altar of health care reform.[19]

Dr. Novak published a column for ABC15 in Arizona, stating that the measure could ultimately save lives. According to Novak, "Prop 106 will guarantee that all Arizonans have the right to spend their own money to obtain legal health care services. Second opinions; additional medical treatments; life-saving legal drugs: No government bureaucrat should ever be able to tell you that your life and health are not worth it."[20]

In that same column by Dr. Novak, the chairman stated that the measure was not worthless, countering arguments from opponents who stated that the measure would not overrule federal mandates. In fact, Dr. Novak stated that the measure would echo throughout the country in certain legal issues. Novak stated, "The truth is, ObamaCare is already being severely tested in our nation’s courts, especially on the grounds that a mandate to buy health insurance or else faces fines and penalties is a massive and unconstitutional overreach by government. Those legal challenges will be stronger if Proposition 106 passes at the polls in November."[20]

In the Publicity Pamphlet published by the Arizona Secretary of State's office, arguments were submitted for the passage of the measure, most notably the following:[21]

Jeffrey A. Singer, MD of Arizonans For Health Care Freedom stated, "In a free society, people should not be forced to participate in a health insurance plan they do not want. In a free society, the people should not be able to dictate to people what kind of -and how much- lawful health care they are allowed to obtain. In a free society, the people should never be blocked from making their own personal arrangements for health care."

Barbara Leff argued, "As many as 20 other states have followed the model we started. As a State Senator I was proud to vote to put this on the ballot to amend our State Constitution. It maintains our rights to spend our own money on medical services we want and lets us opt out of an insurance plan we don't want."

Michelle Andrews of Certified Ortho Tech wrote, "For nearly a year we listened to various politicians tell us what was and what would not be part of health care reform. When the final product was rendered, it was more than 2,000 pages of non-comprehensible language that could be tied up in court for years... You don't need to read hundreds of pages to understand what it means. It will take less than a minute to read it...then vote YES."

Kevin G. Rogers and James W. Klinker of the Arizona Farm Bureau stated, "We need reform in the health insurance marketplace and we need to improve public health insurance programs before we mandate programs that we don't know how we are going to subsidize. Mandated insurance requirements will limit the marketplace and do nothing to control costs."

Campaigning

On August 26, 2010, approximately 100 people rallied at Sahuaro High School in Tucson, leaving with "Yes on 106" yard signs, which were to be used to campaign for the passage of the measure. According to reports, Pima County was an important area for the passage of the measure, as in 2008, a similar measure was rejected by voters, mainly due to weak support in the southern part of the state.[22]

At a debate hosted by Cox Communications and Gateway Community College on September 22,2010, all ten measures on the November ballot in Arizona were argued for and against by both sides of the issues. Proposition 106 was discussed, to where supporter Eric Novack stated about the measure, "All people in Arizona should have the right to choose not to participate in any health care system or plan without paying a penalty, fine or tax."[23]

Opposition

Opponents

State RepresentativeKyrsten Sinema was an opponent of the measure, stating, "Its value is in attempting to shape the debate. Its value is not in making substantive changes at the state level, because federal law supersedes the state constitution."[11]

The League of Women Voters of Arizona stated their opposition to the measure, submitting arguments against the measure in the Arizona Secretary of State's Publicity Pamphlet.[21]

Phil Lopes stated that the passed health care mandates would not prevent people from spending money on the health care services they want.[13]

The Pima County Democratic Party recommended a 'no' vote on the measure.[24]

Arguments

An editorial by the Los Angeles Times stated these arguments against the measure:[17]

It was not clear whether a state constitution can defeat a federal healthcare mandate.

Allowing people to ignore a national mandate to buy insurance would encourage them to carry policies only when they need treatment.

Implicit in proposals such as Arizona's was an every-man-for-himself vision of society.

Why shouldn't the healthy be able to refuse to pay for insurance they're confident they wouldn't use? Because they had a stake in making healthcare affordable for those who needed it. The healthier the public was as a whole, the more productive it would be and the faster the economy could grow.

In a column published by ABC15, Kyrsten Sinema, Assistant House Democratic Leader, gave her reasons why she was against the measure:

The column stated that the measure was a waste of time because the measure could not override federal mandates or laws. The commentary brought evidence on this point, stating, "Prop. 106 is completely useless because the Supremacy Clause of the U.S. Constitution establishes that laws established by Congress are the supreme law of the land. Through Proposition 106, the state may not tell the federal government what to do."

Sinema also stated that the measure was a waste of time because the state had many other issues that it should have been tackling at the time. Sinema stated, "With so many things wrong with our state - Republicans' massive cuts to jobs, education and health care - we've to got to focus on the priorities, not ideological ballot initiatives that fail to yield results."[20]

Rising costs in health care would be the result of uncovered residents that seek emergency care, and that mandated coverage would prevent this.

According to John Wright and Andrew Morrill, president and vice president of Arizona Education Association, "Right now Arizona has the fourth highest percentage of uninsured children in the nation. PROP 106 moves Arizona backwards and away from providing quality, affordable health care to our children."

In the Publicity Pamphlet published by the Arizona Secretary of State's office, arguments were submitted against the measure, most notably the following:[21]

John Wright and Andrew Morrill of Arizona Education Association stated, "Right now Arizona has the fourth highest percentage of uninsured children in the nation. PROP 106 moves Arizona backwards and away from providing quality, affordable health care to our children. The Arizona Education Association requests that you vote NO on PROP 106."

Dr. Bonnie F. Saunders and Dr. Barbara Klein of the League of Women Voters of Arizona argued, " Proposition 106, which allows people to ignore a national mandate to buy health insurance, would encourage them to use emergency room services or to carry policies only when they need treatment. This would increase costs for everyone else, either through higher insurance premiums or taxes. This is not "freedom" for those of us paying the bill."

Phil Lopes argued against the measure, claiming, "The Affordable Health Care Act provides new security and stability for all Americans including those with chronic illnesses, by protecting them from bad insurance company practices and by ensuring coverage is affordable regardless of health status. Passage of 106 would put Arizonans at renewed risk of going without health insurance, and losing the access to health care that insurance provides."

Campaign contributions

Support

Groups or individuals that had donated to the campaign for the measure and the amount they donated are shown in the table below. Donors listed below spent $10,000 or more, thus were listed on the Arizona Secretary of State's website:[26]

1. Prohibit any law or rule from compelling any person, employer or health care provider to participate in any health care system.

2. Allow a person or employer to pay directly for lawful health care services without being penalized or fined.

3. Allow a health care provider to accept direct payment for lawful health care services without being penalized or fined.

4. Provide that the purchase or sale of health insurance in private health care systems shall not be prohibited by law or rule, subject to reasonable and necessary rules that do not substantially limit a person's options.

Proposition 106 would not:

1. Affect which health care services a health care provider or hospital is required to perform or provide.

2. Affect which health care services are permitted by law.

3. Prohibit care provided by law relating to worker's compensation.

4. Affect laws or rules in effect as of January 1, 2009.

5. Affect the terms or conditions of any health care system unless those terms and conditions have the effect of punishing a person or employer for paying directly for lawful health care services or punishing a health care provider or hospital for accepting direct payment from a person or employer for lawful health care services.

Media endorsements

Support

The Desert Lamp stated in an editorial about the measure: "Formally prohibiting the state from enacting any law that would compel participation in a particular health care program is an important, albeit symbolic, step in protecting an individual’s right to choose."[28]

Goldwater State was for the measure, stating, "The events of 2010 show 2008's "no" to have been a grave mistake; let's correct it this year, score a propaganda coup for, and open a legal front for health care freedom. Vote "yes" on Prop. 106."[29]

Opposition

The Arizona Republic was opposed, saying, "Voters should be wary about opening the floodgates for every special interest to protect its pet causes with constitutional writ."[31]

The East Valley Tribune recommended a 'no' vote on the measure, stating, "Much of this referral was originally meant to counter the public-option component of federal reform — a moot point because it no longer includes such a public option. Beyond that, this proposition may be legally pre-empted by federal law, which could result in needless lawsuits. We understand the desire to fight back against federal health care, but this is a pointless way to do it."[32]

The Yuma Sun was against the measure, stating in an editorial: "Although Proposition 106 is proclaimed by supporters as being about “choice,” it more accurately is at attempt to head off a national health care system and reduce choice."[33]

Polls

A poll conducted by Rocky Mountain surveying 555 registered voters in the state showed that 38 percent supported the measure. The poll was conducted during October 1-10, 2010, and had a margin of error of 4.2 percentage points.[34]

Legend

Position is ahead and at or over 50% Position is ahead or tied, but under 50%

Date of Poll

Pollster

In favor

Opposed

Undecided

Number polled

October 1-10, 2010

Rocky Mountain Poll

38%

31%

31%

555

Litigation

On August 12, 2010, a 78-page lawsuit was filed by the Goldwater Institute and Arizona lawmakers against the federal health care mandates. The suit, filed in the U.S. District Court in Phoenix, disputed key points in the new health care law, focusing on the requirement to purchase health insurance. Other plaintiffs in the case include U.S. Representatives Jeff Flake, Trent Franks and John Shadegg. The lawsuit was not directly correlated to the proposed constitutional amendment. According to attorney Clint Bolick, who was in the case, "Congress simply does not have the power under the 'commerce clause' to require an individual mandate. This is the first time that Congress has attempted to compel individuals to buy a private product."[35][36]

Voters in Missouri got a chance to decide whether or not to block the federal government from requiring people to buy health insurance and ban punishment for those without health insurance. Advocates said the measure would "protect the individual’s right to make health care decisions." Opponents of the measures and some constitutional scholars say the proposals are mostly symbolic, intended to send a message of political protest, and have little chance of succeeding in court over the long run.

Previous years

The proposed health insurance reform amendment was similar to a November 2008 proposition that narrowly failed, Proposition 101. However, the new version had some changes that took into account the main criticism levied against the 2008 measure. The new version ensured that patients covered under the Arizona Health Care Cost Containment System would not be negatively impacted if the amendment passed. In 2008, AHCCCS officials argued that Proposition 101 would increase costs by preventing the agency from requiring patients to seek services from within its network of providers.[3]